Action Planning Form

Attachment H: Action Planning Form

Culture of Continuous Learning Project:

A Breakthrough Series Collaborative for Improving Child Care and Head Start Quality

The purpose of the information collection is to help document the focus of improvement for Core BSC Teams. This information would be used to document the goals set by sites for improvement and, when analyzed along with subsequent PDSA worksheet information, may identify which individuals and sites were most successful in carrying out their Action Plan. Guidance for utilizing this form is described in more detail in person at the Learning Sessions

This information is planned to be used to further the proper performance of the functions of the agency by assessing the extent to which child care and Head Start teachers actively engage in data use and monitoring to inform continuous quality improvement.

Public reporting burden for this collection of information is estimated to average 15 minutes per response. This collection of information is voluntary and all responses collected will be kept private to the extent permitted by law.

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. The OMB number for this information collection is 0970-XXXX and the expiration date is XX/XX/XXXX.

Action Planning: Where Should We Begin?

Driver Being Addressed	How will we do it?		How will we measure success?	Who will do it?	When will it get done?	How will we follow up?
What is the secondary driver we are trying to address with this PDSA cycle?	What change will be tested?	What tasks need to be done to prepare for the test? (gather data, bring in more people, create materials, inform staff or leader, etc)	What metric, data, or outcome will we be watching to see if this change is making things better?	Who will have primary responsibility? Who else needs to be involved?	What are the short-term timelines	How will we keep track of our progress on this? How will it be shared with the rest of the team?